| Objective This study intends to explore anatomical resection versus non-anatomical resection in laparoscopic minor resections of liver.The advantages and disadvantages of anatomical hepatectomy and non-anatomical hepatectomy in minor resections were explored by comparative study of intraoperative conditions,postoperative recovery indicators,and hospital economic indicators.Methods In this study,patients who underwent laparoscopic minor anatomical hepatectomy or non-anatomical hepatectomy were selected as the study subjects for retrospective analysis.All of patients are collected from the Department of Liver,Biliary,Pancreatic and Splenic Surgery of the hospital between January 2016 and December 2019.The study subjects were divided into two groups: those who underwent laparoscopic minor resections by anatomical method,and those who underwent laparoscopic minor resections by non-anatomical method.The indexes of serum albumin(ALB),total bilirubin(T-Bil),glutamic pyruvic transaminase(ALT),glutamic oxaloacetic transaminase(AST),gamma-glutamyltransferase(?GGT),operation time,intraoperative blood loss,postoperative hospital stay,gender,age,hypertension,diabetes or other related diseases,economic consumption during hospitalization and other related indexes were observed and statistically analyzed.Results In this retrospective study,52 patients were screened,including 29 patients in the anatomical resection group and 23 patients in the non-anatomical resection group.Among all subjects,there were 19 males(36.5%)and 33 females(63.5%),with a male to female ratio of 1 : 1.7 and a mean age of 50.92± 11.77 years.Preoperative hypertension occurred in 7 patients(13.5%),diabetes in 6 patients(11.5%),and other diseases such as chronic bronchitis and renal cysts in 16 patients(30.8%).Average maximum diameter of lesions were(7.33±2.14)cm.The lesions of all study subjects were confined within 2 liver segments.The lesions were located in the left lateral lobe in the AR group,and all but 3 cases were located in the anterior lobe of the liver(IVb,V,IV)in the NR group.There was no significant difference in the above indicators between the two groups(P > 0.05).The types of diseases included in the study subjects in the two groups were 31 cases(59.6%)of hepatic hemangioma,5 cases(9.6%)of local nodular hyperplasia of the liver,6 cases(11.5%)of hepatic hydatid disease,3 cases(5.8%)of hepatic cyst,2 case(3.8%)of hepatic leiomyolipoma,2 case(3.8%)of cholelithiasis,and 3 case of malignant tumor of liver.Preoperative Child-Pugh liver function classification of all subjects was grade A,serum albumin(g/L)(42.77 ± 2.74 vs 43.49 ± 3.62,P>0.05),glutamic oxaloacetic transaminase(U/L)(20.11 ± 5.94 vs 22.60 ± 12.70,P>0.05),glutamic pyruvic transaminase(U/L)(19.41 ± 10.35 vs 17.21 ± 6.55,?>0.05),gamma-glutamyltransferase(U/L)(27.14 ± 17.09 vs 18.87 ± 5.30,P>0.05),total bilirubin(umol/L)(11.91 ± 3.61 vs 10.62 ± 2.78,?>0.05)in anatomical group and non-anatomical group.There was no significant difference between the two groups.Among the laboratory indicators of patients on the 3th day after operation,there was no statistical difference in serum albumin(g/L)(40.04 ± 5.21 vs 39.60 ± 2.74,P>0.05),glutamic oxaloacetic transaminase(U/L)(36.97 ± 18.39 vs 27.49 ± 7.01,P>0.05),glutamic pyruvic transaminase(U/L)(69.80 ± 37.85 vs 59.07 ± 29.56,P>0.05),gamma-glutamyltransferase(U/L)(40.55 ± 40.73 vs 25.40 ± 12.00,?>0.05)and total bilirubin(umol/L)(19.32 ± 7.26 vs 16.01 ±8.12,P>0.05)between the anatomical group and the non-anatomical group.On the 6th day after operation,the difference in the laboratory indicators between the two groups had significant change compared with before in the levels of glutamic oxaloacetic transaminase(U/L)(29.76 ± 11.91 vs 20.27 ± 3.31,P<0.05),glutamic pyruvic transaminase(U/L)(56.19 ± 27.39 vs 31.71 ± 7.55,P<0.05),and total bilirubin(umol/L)(16.35 ± 6.96 vs 11.45 ± 3.68,P<0.05).There was no statistically significant difference between the two groups in serum albumin(g/L)(40.97 ± 5.76 vs 39.28 ±2.50,P>0.05)and gamma-glutamyltransferase(U/L)(67.83 ± 68.10 vs 39.65 ± 15.10,P>0.05).Among the surgery-related indicators,the operation time(h)in the anatomical resection group(3.05 ± 0.74)was significantly greater than that in the non-anatomical resection group(2.48 ± 0.57),and the difference had statistical significance(P < 0.05).The intraoperative blood loss(ml)in anatomical group(134.66 ± 102.70)was significantly less than that in non-anatomical group(256.52 ± 200.17),and the difference had statistical significance(P < 0.05).Postoperative hospital stay(d)was relatively shorter in the non-anatomical group(11.28 ± 3.32 vs 8.96 ± 1.80,P < 0.05),and economic consumption during hospitalization(?,thousand)was also relatively lower in the non-anatomical group(50.62 ± 12.47 vs 39.16 ± 8.24,P < 0.05).Conclusion 1.In laparoscopic minor hepatectomy,non-anatomic resection is associated with faster postoperative liver function recovery and shorter postoperative hospital stay than anatomic resection.non-anatomic resection is better if rapid postoperative recovery is considered.2.The operation time of anatomical resection is longer than that of non-anatomical resection,but it has certain advantages in less intraoperative bleeding.If the intraoperative blood transfusion volume needs to be strictly grasped according to the patient's own condition,the effect of anatomical resection is better.3.Non-anatomical resection has less overall consumption and is more prominent in saving medical resources and reducing economic consumption. |
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